Children Without Worms (CWW) advocates for a comprehensive approach to soil-transmitted helminths (STH) control by promoting the WASHED framework, which includes potable water, sanitation, hygiene education, and deworming. In the Lobéké area of Cameroon, CWW is collaborating with the Population-Health-Environment (PHE) Program of the World Wildlife Fund (WWF), a program that applies all four components of the WASHED framework to reduce the cycle of STH re-infection.

The Southeast area of Cameroon, home to the Baka hunter-gatherer communities and Bantu people, boasts incredible biodiversity, including lowland gorillas and the forest elephant. Logging, poaching, and slash and burn fires in the late 1980s and early 1990s threatened to upset the balance between people and the natural environment. In 1995, WWF launched the Jengi project, working with the Cameroon Ministry of Environment and Forest to establish the Lobéké, Boumba-Bek, and Nki National Parks to conserve this rich land and the natural resources the local populations relied upon for their livelihoods.

The Jengi project, one of WWF's model projects, promotes sustainable management of the region's forest and wildlife in an approach that includes partnerships with local communities and the private sector. The project began by inventorying the diverse flora and fauna and studying the region's socio-economic aspects. According to Louis Defo, Collaborative Management Advisor of WWF's work in Southeast Cameroon, the project "supported the Cameroonian government in managing the national parks, battling against poaching, creating community hunting zones and forests, and monitoring biological and socio-economic activity."

Louis notes that WWF extended Jengi project objectives through its PHE Program, which tackles "health issues such as AIDS, STDs, malaria, neonatal tetanus, zoonosis, and water-borne illnesses." He states, "The program also promotes family planning, vaccinations against infant diseases, good hygiene and overall health." Adding the PHE program and engaging the local populations to participate in its health-related activities also establishes goodwill among the local population for the WWF's conservation and natural resource management program.

In particular, the PHE program provides education to promote hygiene, access to potable water and improved sanitary latrines, and assistance to local Ministry of Health workers in deworming school-age children with mebendazole donated by Johnson & Johnson-all components of the WASHED framework. By promoting all WASHED components, the project will break the cycle of re-infection by reducing exposure to the parasites' eggs.

According to Louis, "More than 90 percent of the households in the project area do not have latrines; instead, they go to the toilet in nature." As a result, the project team placed latrine construction as the highest priority activity. From 2008 to 2009, WWF collaborated with a Catholic hospital to help 130 households build latrines. Then in 2009, with the support of CWW and Johnson & Johnson, WWF began building latrines at primary schools that were selected according to need, number of students, commitment from school authorities, and location.

Louis also points out that in the project area "the water sources for the households were dirty, and a good part of the population did not respect basic hygiene principles." He believes these factors contribute greatly to the high prevalence of STH infections, which are evident from the "registered visits to doctors and high levels of school absenteeism."

To combat the hygiene and sanitation issues, WWF staff members held meetings in villages around Lobéké National Park to increase hygiene and sanitation awareness. They designed and printed 500 posters to distribute in schools that promote good hygiene and sanitation practices. In addition, they trained numerous primary school teachers to educate the community on conservation, waterborne diseases, diseases of poor hygiene, water treatment methods, and good hygiene and sanitation practices.

To help improve access to potable water, the program worked with a divisional delegate for the Ministry of Energy and Water to select 10 villages for improving water sources. A rural water systems specialist will oversee the work of these water source improvement projects.

The team also monitored distribution of deworming medication to both preschool- and school-aged children at all 28 Lobéké area schools, as well as vitamin A to children aged 1 to 5 years at a nursery school. In addition, they collected data on health indicators in 11 villages, which, Louis notes, "the WWF will use to establish a baseline for the PHE monitoring system so that the team can monitor the project impact."

The PHE project team plans to continue its current WASHED efforts. Louis finds the project especially rewarding because of the continued "requests coming from the villages and schools" for the improvement projects, and the "enthusiasm the village chiefs have for them." He observes that as the local people understand how their environment impacts their health, they become more committed to sustaining the project's activities. With commitment and support from the very people impacted by the projects, CWW and WWF anticipate significantly reducing STH infection rates and other water-borne illnesses in the Lobéké area and improving the health and quality of life for the region's people.

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